BACKGROUND: Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. This deficit is greatest in low- and middle-income countries, especially for specialty surgical services including neurosurgery, due to insufficient personnel, resources, and infrastructure. The southeastern European nation of the Republic of Moldova is one such middle-income country. METHODS: Discussions with key individuals involved in neurosurgical care in Moldova were conducted to characterize the history and current state of neurosurgery in Moldova. Via a process of chain referral sampling, all practicing neurosurgeons in Moldova were invited to participate in the execution and authorship of this project. RESULTS: Developing from origins in the Soviet Union, neurosurgery became part of the national health system in the 1940s, with the creation of the first neurosurgery department in 1999. Eleven hospitals, including eight public and 3 private, offer neurosurgical services, with 239 beds and 5330 cases performed in 2023. Most attending neurosurgeons and residents are male, but this is changing as women comprise over one-third of residents in training. There is one neurosurgery residency program and a 2-year fellowship in endovascular neurosurgery in Moldova, with further fellowship training received outside of the country. Computed tomography and magnetic resonance imaging are available at most centers. CONCLUSIONS: This article provides the first-ever description of the history and current state of neurosurgery in Moldova and presents key recommendations to guide the international neurosurgery community in developing neurosurgical care in countries with an unmet need.